Percutaneous ethanol injection therapy by ethanol mixed with CO₂ microbubble for hepatocellular carcinoma

Abstract

One of the shortcomings of percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma (HCC) is that many sessions are necessary to accomplish the treatment. This may be caused by which the ultrasonography (US) image does not reflect correctly to the kinetics of injected ethanol into HCC nodule. It is considered that number of treatment sessions are able to be reduced if we just enough injected labelled ethanol under US into HCC nodule. Therefore, we tried PEIT by ethanol mixed with CO₂ microbubble (CO₂ ethanol). The injected CO₂ ethanol was aquired as hyperechoic image without strong acoustic shadow to the end of injection. Consequently we could reduce the number of treatment sessions to almost 1 for lesions ≤3 cm in diameter and markedly reduce total dose of injected ethanol. The detectable rate of CO₂ ethanol leaked out HCC nodule was high. No serious complication occured. There have been only 1 lesion of local recurrence and no case of intrahepatic and peritoneal dissemination for 11.5 months on average of observation after PEIT by CO₂ ethanol (CO₂PEIT). These findings suggest that CO₂PEIT is useful method for reducing the number of treatment sessions and total dose of injected ethanol, moreover preventing complication by ethanol leakage.